Japan Digestive Disease Week 2025
International Poster Session6 (JDDW)
October 31, 10:10–10:42, Room 15 (Kobe International Exhibition Hall No.1 Building Digital Poster Venue)
IP-30_S
Upfront Surgery for Advanced Rectal Cancer: An International Collaborative Study
- 1
- Department of Surgery, Kyoto University
- 2
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital
INTRODUCTION The optimal approach for rectal cancer remains debated. This study aimed to assess the role of upfront surgery (US) in managing low-risk, locally advanced rectal cancer.
METHODS This retrospective cohort study analyzed 881 patients who underwent radical resection for cT2-3N+ or cT3N0 rectal cancer at hospitals in Japan and Korea between 2013 and 2021. Postoperative short-term outcomes and disease recurrence were examined, with a median follow-up of 4.7 years.
RESULTS The median age was 64 years (range: 19-92), and the median tumor distance from the anal verge was 6cm (range: 0-15). Treatment strategies were: US (34%, n=298), neoadjuvant chemoradiotherapy (nCRT) (62%, n=547), and neoadjuvant chemotherapy (NAC) (4%, n=36). Compared to US, nCRT and NAC showed higher rates of postoperative complications (19% vs. 24% vs. 33%). Of the 881 patients, 264 were low risk (without cN2, EMVI, involved MRF, or enlarged LPLN). In this group, treatment distribution was: US (n=169), nCRT (n=88), and NAC (n=7). The three-year recurrence-free survival rates were similar between the US and nCRT groups (85% vs. 85%, P=0.73), as were local recurrence rates (2.2% vs. 1.3%, P=0.41).
CONCLUSION This study supports upfront surgery as a viable, less intensive treatment option for patients with favorable prognostic factors.
METHODS This retrospective cohort study analyzed 881 patients who underwent radical resection for cT2-3N+ or cT3N0 rectal cancer at hospitals in Japan and Korea between 2013 and 2021. Postoperative short-term outcomes and disease recurrence were examined, with a median follow-up of 4.7 years.
RESULTS The median age was 64 years (range: 19-92), and the median tumor distance from the anal verge was 6cm (range: 0-15). Treatment strategies were: US (34%, n=298), neoadjuvant chemoradiotherapy (nCRT) (62%, n=547), and neoadjuvant chemotherapy (NAC) (4%, n=36). Compared to US, nCRT and NAC showed higher rates of postoperative complications (19% vs. 24% vs. 33%). Of the 881 patients, 264 were low risk (without cN2, EMVI, involved MRF, or enlarged LPLN). In this group, treatment distribution was: US (n=169), nCRT (n=88), and NAC (n=7). The three-year recurrence-free survival rates were similar between the US and nCRT groups (85% vs. 85%, P=0.73), as were local recurrence rates (2.2% vs. 1.3%, P=0.41).
CONCLUSION This study supports upfront surgery as a viable, less intensive treatment option for patients with favorable prognostic factors.
- Index Term 1: Advanced rectal cancer
- Index Term 2: Neoadjuvant treatment